Method and system for patient management using rules engine

ABSTRACT

A method of patient management including receiving therapy data associated with a plurality of durable medical devices and a first set of patients, and displaying an overview of patient compliance and a plurality of customizable tiles. The overview of patient compliance includes at least the number of patients in the first set of patients, current compliance data, compliance history data, and follow-up data. The plurality of aligned tiles includes at least a title and a plurality of selectable subtitles, each of the plurality of selected subtitles associated with one or more rules. Upon selection of a first selectable subtitle, displaying at least an indication of patients in a second set of patients, wherein the second set of patients is a subset of the first set of patients; upon selection of a first patient, displaying at least all of the rules triggered by the first patient.

INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.16/481,047, filed Mar. 6, 2020, which is a U.S. National Phase ofInternational Patent Application No. PCT/IB2018/050472, filed Jan. 26,2018, which claims priority to U.S. Provisional Application No.62/450,819, filed Jan. 26, 2017, which is hereby incorporated byreference herein in its entirety.

Any and all applications for which a foreign or domestic priority claimis identified in the Application Data Sheet as filed with the presentapplication are hereby incorporated by reference under 37 CFR 1.57.

FIELD OF THE INVENTION

The present technology is directed towards management of therapy for theamelioration, treatment, or prevention of respiratory disorders. Morespecifically, it is directed towards a patient management system havinga rules engine to monitor patient compliance.

BACKGROUND TO THE INVENTION

Insurance companies, or other reimbursing entities (payors), oftenrequire evidence that a patient prescribed with respiratory pressuretherapy has been compliant, that is, used their respiratory pressuretherapy (“RPT”) device according to certain a compliance standard beforereimbursing the patient for the RPT device. Compliance standardsgenerally require some minimum amount of usage per session for somefraction of a number of consecutive sessions known as the complianceperiod. One example of a compliance standard for Continuous PositiveAirway Pressure (CPAP) therapy common to many payors, known as the CMScompliance standard, is that a patient is required to use the RPT devicefor at least four hours a night on at least 21 of 30 consecutive days.In order to determine a patient's compliance, a provider of the RPTdevice (such as a durable medical equipment provider or DME agent, alsosometimes referred to as a home medical equipment provider or HME agent)may manually obtain data describing the patient's therapy using the RPTdevice, calculate the device usage from the therapy data, and comparethe usage with the compliance standard. Once the DME agent hasdetermined that the patient is compliant according to the compliancestandard, the DME agent may notify the reimbursing entity that thepatient is compliant. This process can be costly, time-consuming, anderror-prone if conducted manually. RPT devices typically thereforecontain data management capability that enables the RPT device to storeand transmit therapy data to a remote server to determine automaticallywhether the patient has used the RPT device in accordance with thecompliance standard.

SUMMARY OF THE INVENTION

In a first aspect there is provided a patient management systemcomprising:

-   -   a data management server in communication with a plurality of        durable medical equipment (DME) devices configured to provide a        therapy to a plurality of patients, the data management server        configured to:    -   receive, via a network, data from each of the plurality of DME        devices, wherein the data comprises at least one of DME therapy        data or patient identifying data,    -   assess the received data, and    -   based at least in part on a determination that the received data        satisfies at least one rule, cause an indication of an alert        condition.

The plurality of DME devices may comprise a plurality of respiratorypressure therapy devices.

Each of the plurality of respiratory pressure therapy devices may beconfigured to deliver respiratory pressure therapy to a patient in theform of pressurized air to an airway of the patient during a therapysession.

The data may comprise one or more variables of therapy delivered to thepatient by at least one of the plurality of DME devices.

The data management server may be further configured to:

-   -   identify an action of a plurality of actions;    -   perform the identified action;    -   adjust one or more settings of the alert condition, wherein said        adjusting includes at least muting the alert condition; and    -   re-assess the received data.

The identified action may comprise at least one of add patient notes,update prescription data, contact a patient, order new equipment, orgenerate a patient report.

Said updating prescription data may comprise at least one of modifying,cancelling, or renewing a prescription.

To assess the received data, the patient management system may beconfigured to determine patient compliance based at least in part on amonitored therapy treatment of the one or more patients and a prescribedtherapy treatment of the one or more patients.

Said muting the alert condition may comprise muting the alert conditionfor a predefined period of time.

The rule may comprise a condition associated with at least one ofpatient usage data, therapy duration, timestamp information or equipmentinformation.

Each rule of the plurality of rules may define a set of patients thatsatisfies a particular rule, wherein a set of patients that satisfiesthe particular rule is a subset of the plurality of patients of whichtherapy is provided by the plurality of DME devices.

The data management server may be further configured to cause a displayto display information indicative of one or more of the plurality ofrules and information indicative of one or more patients.

Satisfying a rule may indicate that a patient is not in compliance witha prescribed therapy treatment.

The data management server may be further configured to cause anindication that one or more patients do not meet one or more efficacythresholds.

In another aspect there is provided a method of patient managementcomprising:

-   -   assessing activity of one or more patients of a group of        patients;    -   indicating an alert condition is present based at least in part        on the assessed activity, the alert condition indicative of one        or more patients satisfying one or more rules;    -   receiving a first action of a plurality of actions;    -   performing the first received action;    -   adjusting one or more settings of the alert condition, wherein        said adjusting includes at least muting the alert condition; and    -   re-assessing patient activity.

Each action of the plurality of actions may be associated with at leastone of adding patient notes, updating prescription data, contacting oneor more patients, ordering new equipment, and generating a patientreport.

Updating prescription data may comprise at least one of modifying,cancelling, or renewing a prescription.

Said assessing activity may comprise determining patient compliancebased at least in part on a monitored therapy treatment of the one ormore patients and a prescribed therapy treatment of the one or morepatients.

Muting the alert condition may comprise muting the alert condition for apredefined period of time.

The one or more rules may include a condition associated with at leastone of patient usage data, therapy duration, timestamp information,equipment information.

Each rule of the one or more rules may define a set of patients thatsatisfies the associated rule, wherein the set of patients thatsatisfies the associated rule is a subset of the group of patients ofwhich activity is assessed.

The method may further comprise displaying information indicative of oneor more of the plurality of rules and information indicative of one ormore patients.

Satisfaction by a first patient of one or more rules may indicate thatthe first patient is not in compliance with a prescribed therapytreatment.

The method may further comprise providing indication that one or morepatients do not meet one or more efficacy thresholds.

In another aspect there is provided a patient management systemcomprising:

-   -   a data management server in communication with a plurality of        DME devices and configured to receive use data from the        plurality of DME devices, wherein the use data is associated        with a first set of the plurality of patients; and    -   a patient compliance monitoring system in communication with the        data management server, wherein the patient compliance        monitoring system is configured to provide a displayed        indication of the use data for the plurality of DMEs, wherein        the displayed indication of the use data comprises:        -   an overview of patient compliance, wherein the overview of            patient compliance includes at least a number of patients in            the first set of patients, current compliance data,            compliance history data, and follow-up data; and        -   a plurality of customizable tiles, wherein the plurality of            customizable tiles includes at least a title and a plurality            of selectable subtitles, each of the plurality of selected            subtitles associated with one or more rules;        -   wherein the patient compliance monitoring system is further            configured to:            -   receive a first selection of a first selectable                subtitle;            -   responsive to the selection of a first selectable                subtitle, update the displayed indication to include an                indication of one or more patients in a second set of                patients, wherein the second set of patients is a subset                of the first set of patients;            -   receive a second selection corresponding to a first                patient of the second set of patients, and            -   responsive to the second selection, update the displayed                indication to include an indication of one or more rules                triggered by the first patient.

The one or more rules may be associated with at least one of patientusage data, therapy duration, timestamp information, equipmentinformation.

The display device may be further configured to provide an indicationthat one or more patients do not meet one or more efficacy thresholds.

The one or more efficacy thresholds may be variable efficacy thresholds.

The one or more variable efficacy thresholds may comprise one or moremoving averages.

The one or more rules triggered by the first patient may indicate thatthe first patient is at risk of non-compliance with a prescribed therapytreatment.

The displayed indication may further include a report, the reportcomprising information associated with at least one of monitored patientperformance, patient notes, proscribed patient treatment, and patientidentifying information.

In another aspect there is provided a method of patient managementcomprising:

-   -   receiving therapy data associated with a plurality of durable        medical devices and a first set of patients;    -   causing a display to display an overview of patient compliance        and a plurality of customizable tiles, wherein the overview of        patient compliance includes at least the number of patients in        the first set of patients, current compliance data, compliance        history data, and follow-up data, wherein the plurality of        customizable tiles include at least a title and a plurality of        selectable subtitles, each of the plurality of selected        subtitles associated with one or more rules;    -   responsive to a selection of a first selectable subtitle,        causing the display to display at least an indication of one or        more patients in a second set of patients, wherein the second        set of patients is a subset of the first set of patients; and    -   responsive to a selection of a first patient, causing the        display to display at least one or more rules triggered by the        first patient.

The one or more rules may be associated with at least one of patientusage data, therapy duration, timestamp information, equipmentinformation.

The method may further comprise providing indication that one or morepatients do not meet one or more efficacy thresholds.

The one or more efficacy thresholds may be variable efficacy thresholds.

The one or more variable efficacy thresholds may comprise one or moremoving averages.

The rule triggered may suggest that a patient is at risk ofnon-compliance with a prescribed therapy treatment.

The method may further comprise generating a report, the reportcomprising information associated with at least one of monitored patientperformance, patient notes, proscribed patient treatment, and patientidentifying information.

In another aspect there is provided a system which monitors patientcompliance for a plurality of patients of prescriptions for using aplurality of durable medical devices (DMEs) in order to improve patientusage of the DMEs, the system comprising:

-   -   a data management server in communication with the plurality of        DMEs, the data management server configured to receive use        information of the plurality of DMEs;    -   a patient compliance monitoring system configured to provide a        displayed indication of the use information of the plurality of        DMEs, wherein the patient compliance monitoring system        automatically organizes the use information based on one or more        compliance rules preprogramed or selected by a user, the one or        more compliance rules configured to organize the information        into a format that indicates to a user information regarding        compliance of the DMEs so that the user can determine one or        more groupings of the plurality of patients that have similar        compliance of the DMEs in order to allow the user to improve or        confirm compliance with the prescriptions.

The displayed indication of the use information may comprise a pluralityof tiles representing the one or more groupings of the plurality ofpatients that have similar compliance of the DMEs.

At least one tile of the plurality of tiles may represent patients ofthe plurality of patients at risk of non-compliance.

The at least one tile may represent patients at risk of non-compliancewithin 7 days, 14 days, or one month.

Each tile of the plurality of tiles may display a number of patientsrepresented by the particular tile.

Each tile of the plurality of tiles may be configured to expand to listindividual patient information.

Individual patient information may comprise at least a patient nameand/or contact information.

Clicking on or selecting the patient name, the contact information, orother information of the individual patient information mayautomatically send a text or initiates a phone call.

The text or phone call may initiate an automated message to a patientidentified by the individual patient information.

Clicking on or selecting the patient name, the contact information, orother information of the individual patient information may allow a userto can change the patient's prescription.

The automated message may comprise an indication of one or more links totutorials to instruct the patient identified by the individual patientinformation as to how to improve that patient's usage and/or compliance.

The individual patient information may comprise an indication ofprevious contact attempts and/or results.

The individual patient information may comprise a compliance history.

The individual patient information may comprise an indication ofrecommended actions to improve patient compliance.

At least one tile of the plurality of tiles may comprise an indicationof recommended actions to improve patient compliance.

At least one tile of the plurality of tiles may include metrics forpatients of a particular group of the plurality of patients.

The individual patient information may comprise Apnea-Hypopnea Index(AHI) information.

The individual patient information may comprise an indication of anamount of time a particular patient uses a DME of the plurality of DMEs.

At least one tile of the plurality of tiles may represent patients ofthe plurality of patients which are non-compliant.

The at least one tile may represent patients which have beennon-compliant for at least 30 days or at least 90 days.

At least one tile of the plurality of tiles may represent patients ofthe plurality of patients to follow up with.

The at least one tile may represent patients to follow up with after 2days, 1 week, or 2 weeks.

In another aspect there is provided a method for monitoring patientcompliance for a plurality of patients of prescriptions for using aplurality of durable medical devices (DMEs) in order to improve patientusage of the DMEs, the method comprising:

-   -   receiving, at a data management server in communication with the        plurality of DMEs, use information of the plurality of DMEs;    -   providing, via a patient compliance monitoring system, a        displayed indication of the use information of the plurality of        DMEs; and    -   automatically organizing the use information based on one or        more compliance rules preprogramed or selected by a user, the        one or more compliance rules configured to organize the        information into a format that indicates to the user information        regarding compliance of the DMEs so that the user can determine        one or more groupings of the plurality of patients that have        similar compliance of the DMEs in order to allow the user to        improve or confirm compliance with the prescriptions.

The displayed indication of the use information may comprise a pluralityof tiles representing the one or more groupings of the plurality ofpatients that have similar compliance of the DMEs.

At least one tile of the plurality of tiles may represent patients ofthe plurality of patients at risk of non-compliance.

The at least one tile may represent patients at risk of non-compliancewithin 7 days, 14 days, or one month.

Each tile of the plurality of tiles may display a number of patientsrepresented by the particular tile.

The method may further comprise responsive to a selection of a firsttile of the plurality of tiles, causing the displayed indication of theuse information to display an expanded list of individual patientinformation.

Individual patient information may comprise at least a patient nameand/or contact information.

The method may further comprise automatically sending a text orinitiating a phone call in response to a user clicking on or selectingthe patient name, the contact information, or other information of theindividual patient information.

The text or phone call may initiate an automated message to a patientidentified by the individual patient information.

The automated message may comprise an indication of one or more links totutorials to instruct the patient identified by the individual patientinformation as to how to improve that patient's usage and/or compliance.

The method may further comprise changing the patient's prescription inresponse to a user clicking on or selecting the patient name, thecontact information, or other information of the individual patientinformation.

The individual patient information may comprise an indication ofprevious contact attempts and/or results.

The individual patient information may comprise a compliance history.

The individual patient information may comprise an indication ofrecommended actions to improve patient compliance.

At least one tile of the plurality of tiles may comprise an indicationof recommended actions to improve patient compliance.

At least one tile of the plurality of tiles may comprise metrics forpatients of a particular group of the plurality of patients.

The individual patient information may comprise Apnea-Hypopnea Index(AHI) information

The individual patient information may comprise an indication of anamount of time a particular patient uses a DME of the plurality of DMEs.

At least one tile of the plurality of tiles may represent patients ofthe plurality of patients which are non-compliant.

The at least one tile may represent patients which have beennon-compliant for at least 30 days or at least 90 days.

At least one tile of the plurality of tiles may represent patients ofthe plurality of patients to follow up with.

The at least one tile may represent patients to follow up with after 2days, 1 week, or 2 weeks.

For purposes of summarizing the disclosure, certain aspects, advantagesand novel features of several embodiments have been described herein. Itis to be understood that not necessarily all such advantages can beachieved in accordance with any particular embodiment of the embodimentsdisclosed herein. Thus, the embodiments disclosed herein can be embodiedor carried out in a manner that achieves or optimizes one advantage orgroup of advantages as taught herein without necessarily achieving otheradvantages as can be taught or suggested herein.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram of a patient management system according tosome embodiments.

FIG. 2 is a flow chart illustrating a process carried out by the therapymanagement server 104 in the patient management system of FIG. 1 ,according to some embodiments.

FIG. 3 is a flow chart illustrating a process carried out by the therapymanagement server 104 in the patient management system of FIG. 1 ,according to some embodiments

FIG. 4 illustrates a graphical user interface (“GUI”) presented on adisplay according to some embodiments.

FIG. 5A illustrates an example display responsive to a selection of asubtitle.

FIG. 5B illustrates an example display responsive to a selection of apatient name.

FIG. 6A illustrates an example display responsive to a selection of asubtitle.

FIG. 6B illustrates actions available to the DME agent, according tosome embodiments.

FIG. 7 illustrates recorded patient notes within the patient managementsystem, according to some embodiments.

DETAILED DESCRIPTION

Studies have shown that many of patients prescribed with CPAP therapy,non-invasive ventilation therapy, nasal high flow therapy, and the likehave at least some problems meeting compliance standards. While strictunderperformance thresholds are widely used to provide an alert to a DMEagent, the strict thresholds have proven unhelpful due to constantunderperformance alerts. Accordingly, a need exists to provide a DMEagent with a simple user interface to manage patients, track compliance,and provide a notification when actions need to be taken with respect toindividual patients. In addition, a need exists to monitor one or morerolling averages rather than absolute thresholds. For example,implementing variable efficacy thresholds allows incremental improvementof a user's performance over time without providing constantunderperformance alerts.

Additionally, the strong need exists to further improve patientoutcomes, raise the compliance rate of patients, and decrease the rateof non-compliance related insurance coverage issues. In addition, thereexists a need to provide DME agents with information about the progressof their patients' therapy, in such a way that patients experiencingcompliance difficulties are prominently featured. For instance, thepatient management system can provide a history of patient usage and DMEagent actions. In addition, the patient management system can providewarnings that indicate that a patient is as risk of non-compliance ifthat patient continues therapy at her current actual usage.

The disclosed patient management system applies a number of rules todata obtained from one or more medical devices to monitor patientcompliance and allow users to be grouped according to theircharacteristics, as defined by the rules. Each rule can include acondition that is related to one of more features of any combination ofpatient usage data, therapy duration, timestamp information, equipmentinformation, and other external data. A rule is satisfied if thecharacteristics of the input data to the rule satisfy the specifiedcharacteristics of the rule. The rules can include a variety ofconditions, ranging from time-based conditions to compliance riskconditions.

The patient management system can apply one or more rules or rule setsto data obtained from a medical device associated with a patient. Eachrule defines a group of patients that satisfy the rule. After patientsare grouped according to appropriate rule sets, the rules and members ofeach group are displayed for the DME agent, healthcare professional orservice provider on the patient management system graphical userinterface (GUI). The rules can be used to determine which patients arenot in compliance (or are below an optical compliance) with theprescribed therapy treatment. Accordingly, “satisfying” or “triggering”a rule may be an indication that the patient is in non-compliance with aprescribed therapy treatment, an indication that sub-optimal therapy hasbeen recognized, or an indication that some other event of interest to aDME agent's therapy management (or administrative processes) has beenidentified.

For purposes of this disclosure and as non-limiting examples, a DMEagent can be a distributor of durable medical equipment, an intermediarybetween an insurance company (or payor) and a patient, or someone who isotherwise allied with the insurance company (or payor) such as acontractor.

To facilitate patient compliance monitoring, a standard set of rules isprovided within the patient management system. Additionally, if a DMEagent wants a rule outside the standard rule set, he or she can composea new rule or make a request that a new rule be written. For example,the rules may be written in a script editor or composed using agraphical “drag and drop” interface having predetermined blocks.Creating new rules can be especially advantageous when a DME agent isconcerned with more than one clinical parameter. For example, a DMEagent may desire a rule providing an alert for a high (Apnea-HypopneaIndex) AHI and a corresponding high mask leak.

The standard set of rules and/or the rules displayed on the patientmanagement system GUI can vary from country to country. For example, theUnited States has specific compliance criteria that relates to aprovider's ability to obtain reimbursement from an insurer. In thismarket, rulesets that specifically identify patients at risk ofnon-payment would be included. In Australia, it is important that apatient can quickly acclimatize to a medical device (for example, aCPAP) and achieve and articulable benefit. Thus, in this market, rulesfocused on ensuring patients are getting a full night's sleep (forexample, 6 or more hours) while using their device without technicalissues (such as high mask leak) would be included.

The variety of payors and/or insurance companies may also have an effecton the standard set of rules and/or the rules displayed on the patientmanagement system GUI. This is because different payors and/or insurancecompanies may have differing rules regarding the requirements of theircustomers for being compliant. For example, a first insurance companymay require 70% compliance at a minimum of 4 hours per night over a 30day period, while a second insurance company may also require a specificAHI threshold. In this example, a different set of rules may be used forthe first insurance company and the second insurance company. Thus, thesame rules are not necessarily applied or displayed uniformly to allpatients whose data are in the patient management system.

In some examples, the parameters relevant to the patient's insurancecompany and/or payor can be entered manually by a DME agent. The patientmanagement system can save the conditions for compliance of a newlyentered insurance company such that the same conditions can be appliedto a subsequently entered patient covered by the same insurance company.In other examples, the patient management system is packaged to includea number of common insurance company compliance parameters, and the DMEagent can select the relevant insurance company from a list.

Adjustable Efficacy Thresholds

Many parameters, such as efficacy thresholds, can be monitored byapplying the rules as disclosed herein. Efficacy thresholds relevant toOSA treatment, for example the Apnea-Hypopnea Index (AHI), mask leak,occurrences of central apneas, changes in sleep hours, changes in sleeppatterns (for instance, what times a patient is sleeping and waking),changes in environmental conditions, and changes in subjective data(such as mood collected from supporting Apps), are thresholds thatmeasure the ability of the therapy to produce a desired or intendedresult. These efficacy thresholds can be useful in providing insightinto the effectiveness of respiratory therapy at treating a patientsuffering from OSA.

Different or supplemental thresholds can be monitored by applying therules as herein disclosed for different respiratory therapy treatments.For example, for nasal high flow treatment, device usage duration,patient respiratory rate and patient blood oxygen levels or blood oxygensaturation are thresholds that can provide an indication of treatmenteffectiveness, and can provide a measure of the ability of the therapyto produce a desired or intended result.

The data used to determine the threshold values can be measured andrecorded by the durable medical equipment during treatment. Treatmentsessions may be a number of times per day, for example once per day.This treatment frequency is usually expected for OSA respiratory therapyif the patient has one primary sleep block or session per day, or nasalhigh flow treatment prescriptions with a single treatment session perday. Treatment sessions may occur multiple times per day, as would bethe case for OSA treatment with more than one sleep block per day, ornasal high flow treatment prescriptions with multiple treatment sessionsper day. For example, a nasal high flow treatment prescription caninclude five treatment sessions, each lasting one hour, within a twentyfour hour period.

The standard set of rules and/or the rules displayed on the patientmanagement system GUI can also vary from disease to disease, or diseasestate to disease state. For example, a patient suffering from OSA willhave different compliance criteria, and different relevant compliancemetrics to a patient suffering from Chronic Obstructive PulmonaryDisease (COPD). Thus, for OSA patients, rules relating to AHI, maskleak, or other parameters can be included in the standard set of rules,while for COPD patients, rules relating to device usage duration,respiratory rate and blood oxygen levels can be included.

As one example of an efficacy threshold, the AHI is an index used toindicate the severity of sleep apnea. It is represented by the number ofapnea and hypopnea events per hour of sleep. Combining AHI and oxygendesaturation gives an overall sleep apnea severity score that evaluatesboth the number of sleep disruptions and the degree of oxygendesaturation. The AHI is calculated by dividing the number of apneaevents by the number of hours of sleep. The AHI values for adults arecategorized as: Normal (0-4); Mild sleep apnea (5-14); Moderate sleepapnea (15-29); and Severe sleep apnea (30+).

Typically, patient management systems have fixed AHI thresholds that,when not satisfied, provide an alert indicating underperformance. Forinstance, if a patient's AHI is above 5, an alert may be provided to theDME agent to indicate the therapy isn't working at a sufficient level.

Advantageously, in addition to fixed efficacy thresholds, the rules ofthe disclosed patient management system also utilize adjustable efficacythresholds (for example, for floating or time-dependent thresholds).Accordingly, as opposed to a rule that applies equally to all patients(for example, a rule which notifies the DME agent if a patient has anAHI above a fixed threshold of 5), the described patient managementsystem can include a rule that alerts to the DME agent based on patientimprovements and/or a comparison of moving averages.

For example, a patient having an AHI of 10 would generally trigger arule of AHI>5. However, if that patient had an AHI of 30 prior toundertaking respiratory pressure therapy, it may be advantageous not totrigger an alert to the DME agent because the patient is most-likelyexperiencing a significant improvement in sleep quality. Thus, althoughthe patient would generally trigger a rule of AHI>5 which would alertthe DME agent, in some examples, the rule is not triggered because ofpatient's improvement.

In addition, one or more moving or rolling averages may be utilized todetermine whether a DME agent should be alerted. In the context of theAHI, a moving average of the user's AHI can be calculated over arelatively longer time frame (AHI_(long)) such as a 30 day period and arelatively shorter time frame (AHI_(short)) such as a 5 day period. Insome embodiments, AHI_(long) can be 14, 21, 30, or 60 days (+/− fewdays). In some embodiments, AHI_(short) can be 1, 2, 3, 4, 5, 8, 10, or14 days (+/− few days).

Accordingly, the system can monitor any deviation of AHI_(short) fromAHI_(long). If AHI_(short) (for example, an AHI of 10) is less thanAHI_(long) (for example, an AHI of 30), then the patient's sleep isimproving and the system can advantageously decline to send an alarm tothe DME agent, although the patient would trigger a rule of AHI>5.Moreover, if AHI_(short) (for example, an AHI of 15) is greater thanAHI_(long) (for example, an AHI of 10), then the system can trigger analarm in addition to the alarm for the rule of AHI>5 because the patientis getting worse. In some examples, if AHI_(short) is greater thanAHI_(long), a notification can be provided to the DME agent indicatingthat a condition (for instance, possible high mask leak) is present thatis detrimental to the effectiveness of the therapy on the user.

In some embodiments, the difference between the AHI_(short) andAHI_(long) must satisfy a specified percentage or a fixed value in orderto suppress an alarm. For example, an alarm may be suppressed if theAHI_(short) is 10 index points less than AHI_(long). Similarly, in someembodiments, an alarm (or notification) can be provided to the DME agentwhen the AHI_(short) is greater than AHI_(long) by a fixed percentage orfixed value. For example, the AHI_(short) may be low enough not totrigger an alarm for the rule of AHI>5. However, an alarm can still betriggered if that AHI_(short) is five index points greater thanAHI_(long). In some examples, the fixed value is 2, 4, 6, 8, 10, 12, 14,or 16 index points (+/− a few index points). In some examples, thespecified percentage is 5, 10, 15, 20, 25, 30, 40, or 50 percent (+/− afew percent).

Accordingly, as opposed to a rule that applies equally to all patients(for example, a rule which notifies the DME agent if a patient has anAHI above a fixed threshold of 5), the described patient managementsystem can include a rule that alerts (or suppresses an alert to) theDME agent if the AHI_(short) deviates from the AHI_(long). For example,if AHI_(long) is 10 and AHI_(short) passes over 15, then an alarm forthe rule of AHI_(short)>AHI_(long) can be triggered.

Patient management system rules can include exceptions that preventgeneration of alerts, or automatically mute or hide alerts in certaincircumstances. The exceptions can, for example be implemented for largepercentage changes of low nominal value thresholds or efficacy metrics.This is because a large percentage increase of a low nominal thresholdvalue is also nominally smaller than the same percentage increase of anoriginally larger nominal threshold value. Although both percentageincreases are the same, the end effect on the patient can be moresignificant or more noticeable for the larger nominal increase, and cango unnoticed, or be of smaller significance for the patient with thelower nominal increase.

For example, a central apnea rule can be included in the patientmanagement system that provides an alert to the DME if greater than 30%of apneas detected relating to an OSA patient are determined to becentral apneas. This rule can provide a useful indication into theeffectiveness of the respiratory therapy, and a useful indication intohow the treatment can be adjusted or supplemented to improve futureperformance. If the patient has a low nominal number of obstructiveapneas and central apneas however, the rule can provide an alert whennot necessary, or when said alert won't provide meaningful informationto the DME about the patient's treatment. For example, an increase incentral apneas per hour from 0 to 2 of the patient undergoingrespiratory therapy and experiencing 2 obstructive apneas in the sametime period, in percentage terms is a large increase, as now 50% ofapneas are central. In practical terms however, such a small nominalchange in central apneas is unlikely to significantly affect treatmentor efficacy, and as such, an alert as a result of this change may not beof use. A central apnea rule exception can therefore mute, hide, orprevent from being generated alerts for the rule, if the nominal numberof central apneas is below a nominal threshold, for example 5. The limitor nominal threshold at which the exception stops taking effect can bepre-included in the generic rule, or can be manually set or adjusted bythe DME agent, healthcare professional or service provider.

The central apnea rule can therefore include an exception criteria thatmutes, hides or prevents an alert being generated for large percentageincreases in the number of central apneas, or ratio of central toobstructive apneas, where the nominal increase is low.

More generally, exceptions can be implemented in the rules of thepatient management system to avoid generation of alerts, orautomatically mute or hide the alerts in circumstances where no actionis required, or where action would not materially benefit the patient.These exemptions can be tailored on a patient-by-patient basis,rule-by-rule basis or can be generic.

As mentioned above, similar patient based adjustable efficacy metricscan be applied to mask leak, occurrences of central apneas, changes insleep hours, changes in sleep patterns (for instance, what times apatient is sleeping and waking), changes in environmental conditions,changes in subjective data (such as mood collected from supportingApps), and the like.

FIG. 1 is a block diagram of a patient management system 100 accordingto some embodiments. The patient management system 100 includes durablemedical equipment 102, a data/therapy management server 104, one or morecomputers 110, and a network 106. In some examples, the patientmanagement system 100 can omit one or more of these elements. Similarly,the patient management system 100 can include additional elements. Forexample, in some instances the data/therapy management server 104 caninclude a data/therapy management server and a therapy managementserver.

The durable medical equipment 102 is configured to provide therapy to apatient, transmit data regarding therapy provided to the patient to thedata/therapy management server 104 via the network 106, and/or monitorthe patient. In some examples, the durable medical equipment 102 caninclude a single device or more than one device. For purposes of thisdisclosure, DME is any equipment that provides therapeutic benefits to apatient in need because of certain medical conditions and/or illnesses.

In some embodiments, the durable medical equipment 102 can include arespiratory pressure therapy (“RPT”) device configured to deliverrespiratory pressure therapy to the patient in the form of pressurizedair to an airway of the patient during a therapy session. In someexamples, the medical device is a continuous positive airway pressure(CPAP) device. In some examples, the therapy data collected and/ortransmitted by the durable medical equipment 102 can include devicesettings and/or therapy data describing one or more variables of thetherapy delivered to the patient. For example, the therapy data caninclude AHI, machine runtime, machine usage time, average pressure, 90thpercentile pressure, max pressure reached, average leak, 90th percentileleak, time with excessive leak, apnea index, hypopnea index, centralindex, flow limitation index, humidity, awake state detections, durationof awake state on, ambient temperature, ambient humidity, pressuresettings, comfort settings (for example, awake state and or expiratoryrelief settings), apnea events, hypopnea events, AHI, flow limitationevents, ramps, central events, flow rate, treatment pressure, leak flowrate and the like. In some instances, one or more therapy data can bemonitored and/or recorded at predefined intervals. For instance, thedata can be monitored and/or recorded at 30 second, 1 minute, 2 minute,5 minute, 10 minute, 15 minute, or 30 minutes intervals (+/− a fewminutes). In some instances, one or more therapy data can be monitoredand/or recorded at predefined frequencies. For example, flow rate,therapy pressure, and/or leak rate can be at monitored and/or recordedat 1-50 HZ. In some examples, the durable medical equipment 102transmits data to the data/therapy management server 104, which cancompute the one or more therapy data.

Also connected to the network 106 is a computing device 110 that isassociated with an agent of the durable medical equipment 102 that isresponsible for the therapy of the patient. As mentioned above, the DMEagent can be a distributor of durable medical equipment, an intermediarybetween an insurance company (or payor) and a patient, or someone who isotherwise allied with the insurance company (or payor) such as acontractor. The agent can interact with the data/therapy managementserver 104 over the network 106 via a client program running on thecomputing device 110. The computing device 110 may be any desktop orportable (laptop or notebook) computer, tablet computer, PDA, netbook orsmartphone, and the like.

The patient management system 100 can also contain a patient computingdevice (not shown), associated with a patient, connected to the network106. The patient computing device can be a personal computer, mobilephone, tablet computer, or other device and can be configured tointermediate between the patient and the remotely located entities ofthe patient management system 100 (for example, the therapy managementserver 104), over the network 106. In some implementations, thisintermediation is accomplished by a patient program that runs on thepatient computing device. The patient program may be referred to as a“patient app”.

In some examples, the durable medical equipment 102 is not connected tothe network 106, but is configured to communicate with the patientcomputing device via a local wired or wireless network (not shown) basedon a protocol such as Bluetooth or Wi-Fi. In this alternativeimplementation, the patient computing device (for example, via thepatient app), intermediates between the durable medical equipment andthe remotely located entities of the patient management system over thenetwork 106.

The patient management system 100 can contain information on more thanone patient, each patient with associated durable medical equipment andone or more DME agents. Each DME agent can be responsible for thetherapy of one or more patients.

FIG. 2 is a flow chart illustrating a process 200 carried out by theserver 104 in the patient management system 100 of FIG. 1 , according tosome embodiments. The method 200 may be carried out each time the server104 receives data from the durable medical equipment 102 or on a regularschedule such as every 8, 12, 24, 36, 48, or 72 hours.

At block 220, the sever 104 receives data associated with a plurality ofdurable medical equipment. As mentioned above, this data can includeAHI, machine runtime, machine usage time, average pressure, 90thpercentile pressure, max pressure reached, average leak, 90th percentileleak, time with excessive leak, apnea index, hypopnea index, centralindex, flow limitation index, humidity, awake state detections, durationof awake state, ambient temperature, ambient humidity, pressuresettings, comfort settings (for example, awake state and/or expiratoryrelief settings), apnea events, hypopnea events, Apnea/Hypopnea Index(AHI), flow limitation events, ramps, central events, flow rate,treatment pressure, leak flow rate and the like.

At block 222, the patient management system GUI displays a plurality ofcustomizable tiles. As described in more detail with respect to FIG. 4 ,each tile includes a title and one or more selectable subtitles. Eachsubtitle represents a group of patients which satisfies an associatedrule. A DME agent can interface with the GUI, for example, to reviewpatient compliance information related to one of more features of anycombination of patient usage data, time, equipment information, andother external data. In some examples, the GUI is displayed after asuccessful login to the therapy management server program.

At block 224, the DME agent selects one of the selectable subtitles fromthe GUI. The subtitles can be selected by clicking a pointing device ofthe computing device on the subtitle text.

At block 226, the GUI displays data associated with the subtitleselection. As described in more detail with respect to FIG. 5A, thedisplay shows the rule title and the number of patients whose data iscomplicity with the defined rule. Each patient within the associatedgroup is listed, along with key metrics or context specific data,including context dependent data points extracted from the patient'scomplete data set. Displaying context specific data can help the DMEagent or the viewer of the patient data to quickly establish a possibleroot cause for issues the patient may be having, and act to rectifythem.

At block 228, the DME agent makes a patient selection. The patientselection can be made by clicking a pointing device of the computingdevice on the patient text. Alternatively, the display can include aselectable icon which, when selected, will cause the display to show allthe rules that have been triggered by the selected patient.

At block 230, the GUI displays data associated with the patientselection. As described in more detail with respect to FIG. 5B, thedisplay shows all the rules relevant to the selected patient as well asother patient data, for instance, AHI, Mask data and Sleep Hours.

FIG. 3 is a flow chart illustrating a process 200 of the patientmanagement system, according to some embodiments. At block 330, patientmanagement system issues an alert to a DME agent which notifies the DMEagent that a patient triggered at least one of the rules.

At block 332, an action is selected, entered and performed. FIG. 6Billustrates a variety of options available to the DME agent after analert or notification is issued. These options allow the DME agent toadd or remove a patient from a rule and/or temporarily dismiss a rule.As depicted in FIG. 6B, the DME agent has an option to mark the patientas “Contacted,” “Unable to Contact” and “Exclude.”

In some examples, the patient management system can predict a set oflikely DME agent actions for a particular condition and/or alert. If theDME agent wishes to pursue one of the predicted options, the DME agentcan select it from a list and enter the relevant parameters (forexample, new operating pressure). In some examples, a list of predictedactions can actively prioritize (for example, rank according toeffectivity) based on the success of previous occurrences when the sameaction has been performed on patients with similar characteristics.Logistic regression models or similar machine learning approaches can beused to train algorithms to classify like patients and assess actioneffectivity.

At block 334, the system records the action selected by the DME agent.As described below, each patient in the system has a set of notes thatcontain relevant patient information. The notes can be updated manuallyby the DME agent using an add note field and can also be updated oradded to automatically. Advantageously, notes can be automaticallyrecorded upon the occurrence of certain events. For instance, ruleexceptions, overdue data, prescription changes, changes to the patient'stherapy, rules that the patient is isolated into based on his usagedata, and any other significant activity that happen in the system canbe automatically noted in the patient's records.

At block 336, in response to an action by the DME agent, the system cantemporarily withhold or dismiss the patient from that associated rule toafford the action time to have an effect. This is beneficial when anaction has been taken that will take a certain amount of time to affectthe patient's usage data. For example, if a new mask is ordered toreplace an old, leaking mask, it could take 1-2 weeks before the patientreceives his new mask. Therefore, the patient can be temporarilydismissed from the rule for a time period (the “settling period”) inorder to provide the patient a reasonable time to receive the shipment,setup the new equipment, and/or change a behavior that is causing thealert. For example, because behavior change can take time, the settlingperiod can allow a patient time to settle in and make changes to hisbehavior without causing false positive alerts which could be ultimatelyfixed by the changed behavior.

At block 338, after the settling period has expired, the patient can bereassessed as to whether the action has been effective in resolving thepatient's issue. If the patient's issue has been fixed, then the patientwill no longer trigger the rule. If the patient's issue has not beenfixed by the action, the patient's status can be changed from NEW toFOLLOW UP.

FIG. 4 illustrates a graphical user interface (“GUI”) 400 presented on adisplay having a plurality of customizable tiles 458 a-458 f(collectively 458), according to some embodiments. As mentioned above, aDME agent (or appropriate individual) can interface with the GUI 400,for example, to review patient compliance information related to one ofmore features of any combination of patient usage data, time, equipmentinformation, and other external data. In some examples, the GUI 400 isdisplayed after a successful login to the therapy management serverprogram.

As depicted in FIG. 4 , the GUI 400 includes a plurality of customizabletiles 458 positioned beneath an overview of patient compliance 452. Inalternate embodiments, the tiles 458 and the overview of patientcompliance data 452 can be located in altered positions. For example,the tiles 458 can be positioned at the top of the GUI 400 and/or aroundthe overview of patient compliance data 452.

Each tile 458 includes a title (for example, “At risk of non-compliance”454) and one or more subtitles (for example, “At risk of non-compliancewithin 7 days” 456 a, “At risk of non-compliance within 8-30 days” 456b, and “At risk of non-compliance within 31-90 days” 456 c). In someexamples, the title is representative of the collective set of subtitleswithin the particular tile. For instance, “At risk of non-compliance”454 collectively describes subtitles 456 a, 456 b, and 456 c(collectively 456).

Each subtitle (for example, subtitle 456 a) represents a group ofpatient(s) which satisfies an associated rule. In some examples, thesubtitles can be selected (for example, by clicking a pointing device ofthe computing device 270 on the subtitle text) so as to cause thedisplay to display data corresponding to the group of patientsassociated with the selected subtitle. As described in more detail withrespect to FIG. 5 , responsive to a subtitle selection, the display candisplay an indication of a patient (such as a patient's name) and/ortherapy data of the patients in the associated group. In some, apatient's name may not be available and/or appropriate to display. Forexample, the Health Insurance Portability and Accountability Act (HIPPA)may restrict use of a patient name. In such instances, other indicationsof a patient can be displayed such as an identification numberassociated with the patient and the like.

The text of a subtitle can summarize the rule and/or group associatedwith that subtitle. For instance, the subtitle, “Compliant 30-90 days”in tile 458 b can represent a group containing all of the patients whichhave been compliant for 30 to 90 days.

A specific selectable rule within a tile 458 can be dependent,independent or interdependent on the one or more other selectable rulewithin the associated tile. As an example, two rules may overlap andyield at least one of the same patients. In some instances, anindividual patient which satisfies two or more rules will be presentedin only one of the rules (for example, the “more urgent” rule). Forexample, if a patient triggers both, “at risk of non-compliance within 7days” and “at risk of compliance within 14 days,” the patient may onlybe displayed in the 7 day rule because the patient necessarily triggersthe 14 day rule. As a result, the rules can be interdependently linkedso that if a particular patient is shown in the 7 day rule, thatparticular patient is not shown in the 14 day rule. For example, if apatient triggers both, “at risk of non-compliance within 7 days” and “atrisk of non-compliance within 14 days,” the patient may only bedisplayed in the 7 day rule. However, it will be understood that, insome embodiments, an individual patient can be displayed in each of therules he or she satisfies.

In some examples, the number of patients in a group (for example, thenumber of patients satisfying the associated rule) is also displayedwithin each tile 458 (for example, 450 a, 450 b, and 450 c.)

The GUI can also present on the display an overview of patientcompliance 452. In some examples, such as illustrated in FIG. 4 , theoverview of patient compliance 452 can include the number of monitoredpatients 452 a, current compliance data 452 b, compliance history 452 b,and data regarding patients requiring a follow-up 452 d. In alternativeexamples, the GUI 400 presents the overview of patient compliance 452 tothe DME agent in a manner that emphasizes where potential problems lieand thus where attention is most needed. As described above with respectto adjustable efficacy thresholds, potential problems can be determinedbased on variable thresholds.

FIG. 5A illustrates a display 500A responsive to a selection of the “Atrisk of non-compliance within 7 days” subtitle of FIG. 4 , according tosome embodiments. As mentioned above, the plurality of subtitles of FIG.4 are each associated with a rule and a group of patients conforming tothe rule. In this example, the display 500A shows the rule title (suchas the selected subtitle) and the number of patients whose data iscomplicity with the defined rule. Each patient within the associatedgroup is listed, along with key metrics or context specific data,including context dependent data points extracted from the patient'scomplete data set. Displaying context specific data can help the DMEagent or the viewer of the patient data to quickly establish a possibleroot cause for issues the patient may be having, and act to rectifythem.

The display can include for each patient of the group of patients, apatient name, patient status (for example, new or follow-up patient),compliance status (for example, compliant or non-compliant), compliancerate (for example, since the beginning of their treatment or over thepast 30 days), average use (for example, the average number of hours thepatient has used the therapy during the past 7 days), and patient phonenumber. Additionally, as described in more detail with respect to FIGS.6A and 6B, the display can include a plurality of selectable actionsassociated with each patient.

In this example, a set of patients are displayed which conform to therequirements of a rule specifying they are at risk of non-compliancewithin 7 days. From the display 500A, a user (for example, a DME agent)can select a patient name. The patient name can be selectable (asdescribed above with respect to the subtitles of FIG. 4 ) or,alternatively, the display can include a selectable icon 561 a, 561 b,and 561 c (collectively 561). In either example, upon selecting aselectable patient name or a selectable icon 561, the display will showall the rules triggered by the selected patient (as shown in FIG. 5B).

The selectable icons 561 can indicate the number of rules relevant to aspecific patient. For example, selectable icon 561 a indicates thatthree rules are relevant to the associated patient. In some instances,as depicted in FIG. 5A, patients associated with only a single rule maynot have a selectable icon associated with their name because allrelevant rules are already being displayed.

FIG. 5B displays all of the rules applicable to the selected patient 566according to some embodiments. In this example, the selected patient 566triggers two other rules in addition to the non-compliance after 7 daysrule. By displaying all of the rules associated with a selected patient,a DME agent can more easily keep track of patient performance.

In the illustrated example, all the rules 568 relevant to the selectedpatient 566 are shown as well as other patient data 569 a, 569 b, and569 c (collectively 569). Although FIG. 5B depicts the displayed patientdata as AHI 569 a, Mask data 569 b, and Sleep Hours 569 c, any of theaforementioned therapy data can be displayed.

FIG. 6A illustrates a display 600A responsive to a selection of the“Mask leak above 40 lpm for more than 7 days” subtitle of FIG. 4 ,according to some embodiments. As mentioned above, the plurality ofsubtitles of FIG. 4 are each associated with a rule and a group ofpatients conforming to the rule. In this example, the display 600A showsthe rule title and the number of patients whose data is complicity withthe defined mask leak rule. Each patient within the associated group islisted, along with key metrics or context specific data.

The context specific data 662 shown for this rule includes the averagemask leak per night for the past 7 nights (liters per minute), sleephours and each patient's Apnea-Hypopnea Index (AHI). The parameters thatare shown for each rule are configurable, for instance, by a DME agent.As a result, if the DME agent finds easy access to a particular set ofparameters beneficial in treating patients, and the set is differentfrom the standard parameters, the DME agent can change to the preferredparameters.

FIG. 6A also illustrates a variety of actions 664, 668, 670, 672 thatare available to the DME agent. After selecting a patient from a list,the DME agent can perform a number of activities which may help diagnoseor address a problem further. These include viewing a report of thepatient's performance 668, changing the patient's prescription 664,adding notes 670, or emailing the patient 672.

The change prescription action 664 allows a DME agent to change, cancelor renew a patient prescription based on, for instance, the displayeddata. In some examples, the DME agent can modify the prescription if itis determined that the pressure or humidity delivered to the patient istoo high or too low. In some examples, when a prescription is changed,cancelled or renewed, the user's device can be updated (for instance,automatically updated) with the new prescription information. Responsiveto the alteration of the prescription, the user can get a notificationindicating the change and/or instructions on how the user should proceedwith his or her treatment.

As described further with respect to FIG. 7 , the patient note action670 allows a DME agent to manually add notes on the patient that can besaved and utilized to generate historical records. In addition, notescan be automatically recorded upon the occurrence of certain events. Forinstance, rule exceptions, overdue data, prescription changes, changesto the patient's therapy, rules that the patient has triggered based onhis usage data, and any other significant activity that happen in thesystem can be automatically noted in the patient's records. Thus, thenotes provide an effective route to track a patient's therapy timeline.

The viewing a report action 668 generates a report on the patient'stherapy usage and efficacy for display. By viewing this report, a DMEagent can review a timeline of notes, rules, etc. The DME agent can usethe report to determine historical rule triggers, review activitiestaken in the past such as prescription changes, and see any priorpatient notes.

The email patient action 672 allows the DME agent to email the patient,for instance, to inform him about his treatment. As an example, the DMEagent may desire to email the patient about a high leak over the past 7days and propose a solution such as tightening the headgear or getting anew mask. In some examples, the patient management system canalternatively or additionally allow the DME agent to text orautomatically call (for instance, via automated message) the patient'sphone. Alternatively, where the patient has an app installed on hissmartphone, the system can send a notification to the app for deliveryto the patient. More details regarding courses of action after a DMEagent is notified or alerted are described below.

In some embodiments, in order to avoid potential Health InsurancePortability and Accountability Act (HIPAA) issues, the email patientaction 672 is not available. In examples such as these, the DME agent isstill able to provide guidance and/or direction to the patient. Forinstance, the patient monitoring system can include an option allowingthe DME agent to select from a smart filtered list of possible supportmaterial to send to the patient. For example, if the triggered rule isrelated to mask leak, these smart-filtered options could be links thatshow videos or PDF guides on mask fitting, tightening, and/or cleaningfor the patient.

FIG. 6B illustrates a variety of options available to the DME agentafter an alert or notification is issued. These options allow the DMEagent to add or remove a patient from a rule and/or temporarily dismissa rule. As depicted in FIG. 6B, the DME agent has an option to mark thepatient as “Contacted,” “Unable to Contact” and “Exclude.”

Following a notification, the DME agent can perform an action relevantto the alert. The patient management system can record the action in thepatient's notes, store data relating to the action, and adjust apatient's alert thresholds or required actions for the future. In someexamples, the patient management system can predict a set of likely DMEagent actions for a particular condition and/or alert. If the DME agentwishes to pursue one of the predicted options, the DME agent can selectit from a list and enter the relevant parameters (for example, newoperating pressure). In some examples, a list of predicted actions canactively prioritize (for example, rank according to effectivity) basedon the success of previous occurrences when the same action has beenperformed on patients with similar characteristics. Logistic regressionmodels or similar machine learning approaches can be used to trainalgorithms to classify like patients and assess action effectivity.

A patient is marked as “contacted” if an action has been performed (forinstance, by a DME agent) that may resolve an issue relevant to thealert and ultimately remove the patient from the rule. For example, if apatient has ordered new equipment to replace leaky or broken equipment,the DME agent can mark the patient as contacted because the newequipment may resolve the patient's issues.

In response to a patient being identified as “contacted” with respect toa specific rule, the system temporarily withholds or dismisses thepatient from that associated rule to afford the action time to have aneffect. This is beneficial when an action has been taken that will takea certain amount of time to affect the patient's usage data. Forexample, if a new mask is ordered to replace an old, leaking mask, itcould take 1-2 weeks before the patient receives his new mask.Therefore, the patient can be temporarily dismissed from the rule for atime period (the “settling period”) in order to provide the patient areasonable time to receive the shipment and setup the new equipment. Forinstance, the settling period can be 3 days, 1 week, 2 weeks, 3 weeksetc. In some instances, the settling period is predefined by the system.In other examples, the settling period may be chosen, for instance, bythe DME agent. This approach can drastically reduce the amount of “falsepositives” (for example, alerts based on issued that will soon beresolved) providers have to deal with.

After the settling period has expired, the patient can be reassessed asto whether the action has been effective in resolving the patient'sissue, thereby removing the patient from the rule. If the patient'sissue has not been fixed by the action, the patient's status 676 can bechanged from NEW to FOLLOW UP.

As another example, the DME agent or physician may decide to adjust theprescription of a patient where the patient is detected to have highAHI, even with treatment. Following the action of adjusting theprescription, the patient management system can automatically mute highAHI alerts for the settling period (for example, 7 days), during whichtime the user is able to adjust to the new therapy parameters. Thepatients performance is then be reassessed at the end of the settlingperiod, and if their behavior is still applicable with the rule, the DMEis alerted again.

The settling period can also be implemented in the rule sets utilizingmoving averages, as described above. For example, after a patient with ahigh mask leak has his mask replaced, he is likely to have a lower maskleak. Over time, the short term moving average of mask leak and longterm moving average of mask leak should reduce to reflect this. As aresult, muting the mask leak alarm for the settling period will allowfor a re-adjustment of the moving averages that are used as a base linemetric for measuring the patient's mask leak.

A patient is marked as “unable to contact” in the event that the DMEagent attempted to contact the patient to implement a change in therapyor to provide information as required but the patient was unreachable.In some examples, the patient management system can automatically recordin the patient's notes that the DME agent attempted to contact thepatient however they were unavailable. The patient management system canalso record the time at which the patient was attempted to be contactedand/or the methods attempted. In other examples, the DME agent canmanually update the notes.

In some examples, upon being identified as “unable to contact,” thesystem temporarily (for example, 1 or 2 days) withholds or dismisses thepatient from that associated rule. This advantageously provides time forthe DME agent to find another way to contact the patient and/or time forthe patient to remedy his own situation. Additionally, by temporarilyremoving the patient from the rule, it provides the DME agent assess topatients which still need attention for the day. After the shorttemporary period (for example, 12 hours, 1 day, 2, days, etc.) expires,the patient is automatically added back to the rule to provide the DMEagent another opportunity to remedy the patient's issue. The patient isreturned to the list without the status of NEW, allowing a subsequentattempt to contact the patient and resolve the issue to be made.

A patient is marked as “exclude” when the DME agent decides to removethe patient from the rule, although the patient is not strictly adheringto the rule as applied to all patients. Utilizing this feature, thealerts can advantageously be muted if the DME agent has attempted torectify the situation multiple times to no avail, or the patient is notcontactable. This option can also be utilized to mute the alerts whereit is determined that the patient is performing acceptably, even in thecase where an alert may be being indicated as they aren't meeting acertain desired threshold. For instance, the DME agent may desire toexclude the patient from the rule if the patient is benefiting from thetherapy in a noticeable way, although not strictly adhering to a ruleapplied to all patients. For example, if the patient's AHI is 10 but isexperiencing improved sleep quality, he can be removed from an AHI>5rule that may typically applied to all patients, even though they don'tstrictly meet the typical threshold.

FIG. 7 illustrates recorded patient notes within the patient managementsystem, according to some embodiments. As described above, each patientin the system has a set of notes that contain relevant patientinformation. The notes can be updated manually by the DME agent usingthe add note field 784 and can also be updated or added toautomatically.

Advantageously, notes can be automatically recorded upon the occurrenceof certain events. For instance, rule exceptions, overdue data,prescription changes, changes to the patient's therapy, rules that thepatient is isolated into based on his usage data 782, and any othersignificant activity that happen in the system can be automaticallynoted in the patient's records. Thus, the notes provide an effectiveroute to track a patient's therapy timeline 780, generate historicalrecords, review a history of past conditions and past attemptedremedies, and determine recurring conditions.

In some examples, the patient management system can automatically recordin the patient's notes that the DME agent attempted to contact thepatient however they were unavailable. The patient management system canalso record the time at which the patient was attempted to be contactedand/or the methods attempted. In other examples, the DME agent canmanually update the notes.

Embodiments have been described in connection with the accompanyingdrawings. However, it should be understood that the figures are notdrawn to scale. Distances, angles, etc. are merely illustrative and donot necessarily bear an exact relationship to actual dimensions andlayout of the devices illustrated. In addition, the foregoingembodiments have been described at a level of detail to allow one ofordinary skill in the art to make and use the devices, systems, methods,etc. described herein. A wide variety of variation is possible.Components, elements, and/or steps can be altered, added, removed, orrearranged. While certain embodiments have been explicitly described,other embodiments will become apparent to those of ordinary skill in theart based on this disclosure.

Conditional language used herein, such as, among others, “can,” “could,”“might,” “may,” “e.g.,” and the like, unless specifically statedotherwise, or otherwise understood within the context as used, isgenerally intended to convey that certain embodiments include, whileother embodiments do not include, certain features, elements and/orstates. Thus, such conditional language is not generally intended toimply that features, elements and/or states are in any way required forone or more embodiments or that one or more embodiments necessarilyinclude logic for deciding, with or without author input or prompting,whether these features, elements and/or states are included or are to beperformed in any particular embodiment.

While the above detailed description has shown, described, and pointedout novel features as applied to various embodiments, it will beunderstood that various omissions, substitutions, and changes in theform and details of the devices or algorithms illustrated can be madewithout departing from the spirit of the disclosure. As will berecognized, certain embodiments of the inventions described herein canbe embodied within a form that does not provide all of the features andbenefits set forth herein, as some features can be used or practicedseparately from others. The scope of certain inventions disclosed hereinis indicated by the appended claims rather than by the foregoingdescription. All changes which come within the meaning and range ofequivalency of the claims are to be embraced within their scope.

What is claimed is:
 1. A patient management system comprising: a datamanagement server in communication with a plurality of durable medicalequipment (DME) devices and configured to receive use data from theplurality of DME devices, wherein the use data is associated with afirst set of patients; and a patient compliance monitoring system incommunication with the data management server, wherein the patientcompliance monitoring system is configured to provide a displayedindication of the use data for the plurality of DME devices, wherein thedisplayed indication of the use data comprises: an overview of patientcompliance, wherein the overview of patient compliance includes at leasta number of patients in the first set of patients, current compliancedata, compliance history data, or follow-up data; and a plurality ofcustomizable tiles, wherein the plurality of customizable tiles includeat least a title and a plurality of selectable subtitles, each of theplurality of selected subtitles associated with one or more rules;wherein the patient compliance monitoring system is further configuredto: receive a first selection of a first selectable subtitle of theplurality of selectable subtitles; responsive to the selection of thefirst selectable subtitle, update the displayed indication to include anindication of one or more patients in a second set of patients, whereinthe second set of patients is a subset of the first set of patients;receive a second selection corresponding to a first patient of thesecond set of patients, and responsive to the second selection, updatethe displayed indication to include an indication of one or more rulestriggered by the first patient.
 2. The patient management system ofclaim 1, wherein the plurality of DME devices comprise nasal high flow(NHF) devices.
 3. The patient management system of claim 1, wherein theplurality of DME devices comprise Continuous Positive Airway Pressure(CPAP) devices.
 4. The patient management system of claim 1, wherein theone or more rules are associated with at least one of patient usagedata, therapy duration, timestamp information, or equipment information.5. The patient management system of claim 1, wherein the display deviceis further configured to provide an indication that one or more patientsdo not meet one or more efficacy thresholds.
 6. The patient managementsystem of claim 5, wherein the one or more efficacy thresholds arevariable efficacy thresholds.
 7. The patient management system of claim6, wherein the one or more variable efficacy thresholds comprise one ormore moving averages.
 8. The patient management system of claim 1,wherein the one or more rules triggered by the first patient indicatethat the first patient is at risk of non-compliance with a prescribedtherapy treatment.
 9. The patient management system of claim 1, whereinthe displayed indication further includes a report, the reportcomprising information associated with at least one of monitored patientperformance, patient notes, proscribed patient treatment, or patientidentifying information.
 10. A method of patient management comprising:receiving therapy data associated with a plurality of durable medicalequipment (DME) devices and a first set of patients; causing a displayto display an overview of patient compliance and a plurality ofcustomizable tiles, wherein the overview of patient compliance includesat least a number of patients in the first set of patients, currentcompliance data, compliance history data, and follow-up data, whereinthe plurality of customizable tiles include at least a title and aplurality of selectable subtitles, each of the plurality of selectedsubtitles associated with one or more rules; responsive to a selectionof a first selectable subtitle of the plurality of selectable subtitles,causing the display to display at least an indication of one or morepatients in a second set of patients, wherein the second set of patientsis a subset of the first set of patients; and responsive to a selectionof a first patient of the second set of patients, causing the display todisplay at least one or more rules triggered by the first patient. 11.The method of claim 10, wherein the plurality of DME devices comprisenasal high flow (NHF) devices.
 12. The method of claim 10, wherein theplurality of DME devices comprise Continuous Positive Airway Pressure(CPAP) devices.
 13. The method of claim 10, wherein the one or morerules are associated with at least one of patient usage data, therapyduration, timestamp information, or equipment information.
 14. Themethod of claim 10, further comprising providing an indication that oneor more patients do not meet one or more efficacy thresholds.
 15. Themethod of claim 14, wherein the one or more efficacy thresholds arevariable efficacy thresholds.
 16. The method of claim 15, wherein theone or more variable efficacy thresholds comprise one or more movingaverages.
 17. The method of claim 10, wherein the at least one or morerules triggered suggest that a patient is at risk of non-compliance witha prescribed therapy treatment.
 18. The method of claim 10, furthercomprising generating a report, the report comprising informationassociated with at least one of monitored patient performance, patientnotes, proscribed patient treatment, or patient identifying information.